We know the red flags, but these signs often fly under the radar
The DSM-V (2013) identifies nine specific criteria and symptoms of Borderline Personality Disorder (BPD), of which, five need to be met for a formal diagnosis. These symptoms include: a fear of abandonment (either real, or imagined); chronic feelings of emptiness; emotional dysregulation and instability; identity disturbances; impulsivity (sex, erratic driving, spending; binge eating; drugs/alcohol, relationships); inappropriate or intense anger, or difficulty controlling anger; patterns of unstable and intense relationships; suicidal behavior or gestures; and, dissociation or other stress-related symptoms.
We know the main symptoms. Many of us may know someone who displays a few of these symptoms, whether or not they’ve received formal diagnosis. Or, we may resonate with a few of these symptoms within ourselves, based on patterns in our lives.
If we know the nine main symptoms of BPD, we probably know the “red flag” behaviors of BPD that walk hand-in-hand with these nine main symptoms.
For example, if a person:
- Can’t be alone
- Rushes into relationships or has a history of overlapping relationships
- And/or needs a relationship to support their sense of identity
…these are red flag behaviors associated with the symptoms of: feelings of emptiness, identity disturbance, and patterns of unstable relationships.
If a person:
- Easily flies off the handle
- Is erratic or impulsive in their behavior
- And/or “challenges” those in their life by “testing” the person’s investment to them
…these are red flag behaviors of: fear of abandonment, inappropriate or intense anger, impulsivity, patterns of unstable/intense relationships, and emotional dysregulation.
Less obvious symptoms of BPD are also worth understanding because they tend to show up when a person is experiencing stress, relationship issues, or is struggling with their self-identity.
They May Appear Childlike. This symptom falls in line with unmet needs from childhood where they have suffered severe abuse or neglect and may not have been taught about “adulting”. Many have had to learn about self-care, relationships, or how to be responsible for themselves from the School of Hard Knocks, and as a result, their identity, their understanding of who they are, and their ability to authentically love and care for themselves has been compromised.
Appearing childlike isn’t based on childlike innocence, but on a need to be re-parented. When they emotionally fall apart, become argumentative, or project their fears onto others (some may call it “playing a victim”), it’s actually a cry for help and support. They may either get angry and volatile pushing everyone away so they can “Do it themselves!” as seen in the Petulant or Self-Destructive sub-types, or they may plead for help or support, or look like they can’t care for themselves, as seen in Discouraged or Impulsive sub-types.
Many weren’t taught the basics of how to get a job, how to keep their health in order, how to balance a checkbook, or how to to navigate through relationship ups and downs without extremes of idealization and devaluation. They weren’t taught the basics of “adulting-101” and have had to learn by making mistakes, sometimes not learning from those mistakes, and then becoming discouraged, angered, or self-destructive because of their unmet needs for love and support.
Situational Symptoms; Situational Competence. As with any disorder, it ebbs and flows. A person with BPD is never stuck in their symptoms 24/7. Actually, symptoms come and go depending on their individual triggers. Because intimate relationships (keyword: intimate) tend to trigger fears of abandonment, anger, or identity confusion, other situations that require less emotional investment are less threatening for a person with BPD.
Many prefer casual friends over close friends, and casual relationships over very romantic or intimate ones as these lessen the chance of emotional triggers stepping to the front of the line. If relationships are kept at arms-distance, the main symptom of fearing abandonment is pushed to the sidelines.
Many may excel at their job, especially those that are not triggering to their symptoms. Some with BPD tend to gravitate to careers that don’t involve more intimate contact that could be emotionally triggering, or in fields where they can flex their ability to care for others. It’s common to see those with BPD in fields like nursing, working in a hospital lab, working with animals, or working with computers. In these situations, they can be very competent and their symptoms may not be present because they’re interfacing with things that aren’t triggering their vulnerabilities.
Shoddy and Inconsistent Self-Care. Many weren’t shown how to care for themselves and are unaware of their own unmet needs for love, safety, trust, authenticity, and physical/emotional health. If we peel back the layers of their childhood, some grew up in environments where their own caregivers were a Petulant or Discouraged sub-type who either screamed and abused, or fell to pieces. Neither option is supportive to any child trying to navigate how the world works. If their parents aren’t teaching them how to care for their Self, they aren’t going to know how to.
Because of this, they may not go to the doctor when sick, or they may not have regular physicals or teeth-cleanings. Some may come off as “playing a victim” which further isolates them from getting the support they need. They may not seek mental health support out of feeling ashamed or scared, or they may have poor healthcare habits such as excessive or dangerous dieting, binge eating, extreme or rigid exercise routines, self-medicating, obsessions/compulsions, or over-use of supplements.
Comorbid Mood, Stress, Anxiety Disorders. Comorbid disorders are common when dealing with mental health because some symptoms can mimic other disorders. Misdiagnoses are common, especially if one symptom that’s prominent can also be identified in another disorder. BPD has high incidences of overlaps with mood disorders (bipolar disorder; Major Depressive Disorder), with disorders of stress and trauma such as Post-Traumatic Stress Disorder (PTSD), and with anxiety disorders. Some current studies suggest that as many as 96% of people diagnosed with BPD have co-occurring or alternating depression or anxiety. And, as many as 53% of those diagnosed with BPD also have a dual diagnosis of PTSD.
Because of the risk of these comorbid disorders, they also increase the risk of feeling “out of control”, or feeling misunderstood, which can lead to: an increased risk of substance abuse, or other addictions as a way of trying to feel more in control or emotionally numb.
Skin Irritations, Intestinal Problems, or Autoimmune Issues. Some with histories of BPD may have increased sensitivity with their skin, often as a result of elevated stress hormones such as cortisol. When symptoms of BPD are triggered, some will also see an increase in skin rashes, eczema, hives, skin flushing, intestinal problems, trouble eating, irritable bowels, or symptoms of fibromyalgia as a result of the increases in cortisol in their body.
These symptoms are also common in those with diagnoses of complex PTSD or those who have histories of severe childhood trauma. Symptoms of BPD beg for further research into the parallels between BPD diagnosis and childhood trauma.
Ihave said it often that I wish BPD could be re-categorized as a disorder of stress/trauma or as an attachment disorder since the symptoms begin in childhood or adolescence, and the main criteria is a fear of abandonment.
Because symptoms of BPD are often much broader and more complex than “just” personality traits, it affects a person globally — their sense of Self is compromised, their personality is affected, their emotions, their thoughts, their behavior, their nervous system, and their somatic experiences are all impacted.
originally published on quora.